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Tuesday, July 28, 2009

My first month of internship is coming to an end. I did a month of medicine wards. The hours are long, but it's been interesting. Here are a few quick tidbits from my month:

One patient was a little too happy that I attempted to say hello to her in her own language. As I began to examine her with my gloved hands and stethoscope, I said "Hello" in her language. She suddenly lit up, grabbed both my hands with her own, said "Hello!!!" and proceeded to kiss my gloved hands. Sadly, I think this was actually more sanitary than had she kissed my bare hands.

Constipated patients get used to people asking them about their bowel movements. However, a select few get a little too worked up about their situation. One patient was so happy that he finally had a BM, he very generously saved it for me to examine when I returned the next day. Thanks, buddy.

Nurse: Doctor! The patient is in extreme pain! 10/10! I think we should really give him something for his painDoctor: I just went to see the patient, who I am covering for another doctor. He is sleeping soundly and snoring.Nurse: Yes, but when he wakes up, he will be in extreme pain!Doctor: ...

One time, a fellow intern admitted a patient, who soon after admission had a code blue. In this case, the code blue was because the patient had stopped breathing. This could happen to any patient, but it was funny to hear the intern remark "But he was satting 100% on room air when I left..."

Patient's reason for admission: I ate a bad plum and then vomitted, but I feel better nowThe hospital's reason for admission: rule out heart attack... what?

In general, a quick assessment of mental status is to ask the patient their name, their location, and the date. If they know all three, they are "alert and oriented times 3". However, it's sad when I examine a patient and realize they are more alert and oriented than I am, especially about what day it is.

Me: I spoke with Jennifer, the nurseUnit clerk: Which Jennifer?Me: Uhhh... the one I just spoke with?Clerk: We have 4 nurses named Jennifer on this floor: Jennifer C, Jennifer T, Jennifer P and Jennifer J

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Saturday, July 18, 2009

Wards often cause much consternation for medical students, interns, and residents. This post will be half humorous, half serious, but hopefully all helpful. These are going to be practical tips about your workflow. If you're worried more about looking good on rounds, might I suggest First Aid for the Wards. You might also want to check out:

Buy one of those clipboard/organizer deals. Unless your hospital has a full EMR, you will be filling out forms. A clipboard with storage lets you carry around forms so you don't have to hunt for them on each unit where they will be inevitably hidden a different, illogical location.

Find out where the good/clean restrooms are. I remember hearing this on the interview trail and thinking it a joke, but it is so so true.

Same goes for figuring out where to get food quickly and cheaply.

Sometimes people get all worked up on keeping notecards with every single lab value their patient has had. This is a giant waste of time. All you need are the latest labs, and perhaps the previous values for labs that come back abnormal. If someone asks you a sodium level from a week ago, they are being unreasonable and should look it up themselves.

Figure out how to round in a path that makes sense. Start with the sickest patient, but then walk around in a logical way.

Do as complete an exam as you can during your initial H&P, and then do as little as possible while still addressing the patient's major issues during each follow up. There's no point in not checking pulses initially, but then doing fully neuro exams everyday, unless you're specifically asked to do so.

Use the time when you page or return a page and are put on hold to do other mindless things, like collect labs.

Don't stress too much. Things could be worse - at least you're not the one who is sick in the hospital, right?

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